CARE HOMES FOR OLDER PEOPLE
Brindley Court Nursing And Residential Home Station Street Longport Stoke-on-trent Staffordshire ST6 4ND Lead Inspector
Mrs Yvonne Allen Unannounced Inspection 20th January 2006 09:30a X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Brindley Court Nursing And Residential Home Address Station Street Longport Stoke-on-trent Staffordshire ST6 4ND 01782 828428 01782 828429 brindley.court@ashbourne.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) APTA Healthcare (UK) Limited Ashbourne Homes Limited, Ashbourne Consolidated Group Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52), Physical disability (13) of places Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 13 PD 35 to 65 years Date of last inspection 6th July 2005 Brief Description of the Service: Brindley Court Care Centre provides personal and nursing care for up to fiftytwo male and female persons. The home provides accommodation for mainly older people but can accommodate up to thirteen people, aged between 35 and 60 years on admission who have a physical disability.The home is a two-storey purpose built brick building. It has fifty-two single bedrooms and each of them has an en-suite comprising of a toilet and wash hand basin. The home has lounges and dining facilities on each floor. A passenger lift that is accessible to service users allows easy access around the home. There are appropriately adapted bathing facilities to each floor. There is a central kitchen and laundry.Externally, the home has pleasant secure gardens for service users to enjoy and there is ample parking space. The home is situated close to the A500 and is within easy access of local shops, bus service, a train station and road networks. Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors and took approximately four hours to complete. Not all of the standards were assessed during this visit; those scoring less than 3 on the last inspection and those not assessed last time were examined. Inspectors toured the home and met with residents, staff and visitors. All of the communal areas and a selection of bedrooms were inspected. Discussions were held with the prospective manager and verbal feedback was given at the end of the inspection. What the service does well: What has improved since the last inspection?
The receipt, storage and administration of medication had improved since the last inspection and there were no errors found. Care plans were found to be more consistent and the standard of care planning was generally good. Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4 and 5 Each resident is issued with a written contract once moving into the home. The delivery of personal and nursing care needs to be reviewed and improved upon in order to ensure that individual needs are met on a continuous basis. EVIDENCE: Sample contracts were seen. All residents accommodated in the home have a statement of terms and conditions in place. For residents admitted through Social Services this is in the form of a standard contract and the first six weeks are regarded as a trial period with a review at the end of this. Self-funding residents are given contracts with the home in much the same manner except the trial period was shorter – being four weeks duration. It is recommended that this trial period be increased to six weeks as in standard social services contracts. The manager stated that residents and their families were encouraged to come and view the home prior to admission.
Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 9 It was identified that, although the personal and nursing care provided to residents in the home was generally of a high standard, not all individual needs were being met on a continuous basis. There had been a number of complaints received in relation to personal and nursing care over the last few months and some of these concerns had been upheld. It was also identified that, despite a previous requirement to review the needs of an individual resident at the home, this had not been addressed. It was obvious, through direct observation and examination of the care plan, that this resident required specialist care, which the home were not registered or equipped to provide. This must be addressed as a matter of urgency. Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 The general standard of care planning and assessment of healthcare needs was good but staff must ensure that communication is maintained with representatives and that regular reviews of healthcare and medication take place. The maintenance of comfort and dignity for residents needs to be improved upon and this must be taken through to the end of life with the development of a policy on death and care of the dying. EVIDENCE: A random selection of care plans was examined. The general standard of these was found to be good. Individual risk assessments had been developed and the plans had been evaluated on a regular basis. Individual health care needs had been assessed and monitored with intervention and specialist advice and treatment as required. Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 11 It was identified that one of the residents, about whose care the family had made a complaint, had received specialist help and advice in relation to her general health and well being and monitoring of her health had been good. However, the progress of the monitoring and intervention had not been relayed to the family, as it should have been. Also the resident had not been reviewed by the GP for up to 16 months. This lady had a complexity of needs and should have been reviewed by the GP, at the least to have a medication review annually. The medication process was examined and found to be in order. Previous requirements had been addressed. The care plans examined highlighted the various ways in which individual needs should be met with dignity and allowing privacy. It was identified that staff need to be more mindful of this. One resident was observed asleep in a wheelchair in his bedroom with the door wide open. He was slumped to one side with his right arm dragging on the floor, his head leaning over to one side and unsupported and his false teeth halfway out of his mouth. The resident was left like this for at least an hour with staff walking past his door. The recent complaints have highlighted that the dignity of residents is sometimes compromised with residents having to wait for long periods of time for their call bells to be answered and the most recent complaint identified that the resident was found sitting on her own in the lounge in a soiled incontinence pad, whilst the others were attending an entertainment session. The CSCI complaints team is currently investigating this. The provision and maintenance of privacy and dignity for residents in the home must be improved upon with more staff training and awareness and greater monitoring. There was no policy in place for care of the dying and following death. Neither was there a policy in relation to the procedure for unexpected or sudden death. This information is need by the staff on the floor and must be readily available for reference. Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13 Residents when asked were satisfied with their lifestyle in the home, and they had been able to exercise choice. Contact had been maintained with relatives and friends of residents. Opportunities to access the local community had been made available. EVIDENCE: Trips out to the community had been organised and transport provided. The activity organiser showed the inspector the activities folder, which evidenced the activities both inside and outside the home. Residents spoke of the places visited and also the entertainment within the home, especially bingo, which they loved, and the ‘Make-Over’ day every fortnight. There was open visiting at the home and visitors were noted coming and going at the time of the inspection. Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 There is a clear and accessible complaints procedure displayed in the home. Complaints received had not always been dealt with as effectively as they should have been. The legal rights of residents are upheld wherever possible. EVIDENCE: The complaints procedure had been amended as highlighted in the previous inspection report. There had been a number of complaints received by the CSCI since the last inspection with many issues having been upheld. The complaint reports had stipulated requirements and recommendations, which had not been fully addressed. Residents spoken to stated that they would know who to go to if they had a concern or complaint. The legal rights of residents were upheld wherever possible. The prospective Manager stated that there were currently no residents using advocacy services at the time of the inspection although this service could be easily accessed if required. He stated that two of the residents were using the services of a solicitor. The electoral role had been completed and that, at election times, those residents who wished to vote would be helped to do so. This was a mainly postal vote but some might be able to attend the local polling station.
Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 Residents live in a safe environment, however the maintenance of the building is not satisfactory. The communal areas are in need of refurbishment and the majority of beds, fixtures and fittings need replacing. EVIDENCE: There is a general deterioration evident throughout the home, which needs to be addressed with some urgency. The condition of the ground floor lounge carpets was not acceptable and this had been noted on the last inspection in August. Beds and bedding were showing signs of wear and tear and were not appealing to the eye at all. One bedroom identified to the manager was very malodorous and offensive. The smoking room had still not been decorated as required at the previous visit.
Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 15 Several bedrooms identified to the manager were far from satisfactory. Toilet and bathrooms were found to be clean and tidy. Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Staffing levels were found to be insufficient to meet the needs of the residents and staff were not working as an effective staff team. Recruitment was in need of improvement. Qualifications were satisfactory and staff training was evident to have taken place. EVIDENCE: Due to the dependencies, number of residents and the size of the building the inspectors identified that the staffing levels and efficiency were inadequate. Also, the number of complaints received and the seriousness of the issues identified and, in some cases, upheld, identified that the staff were not working as an effective team. The ancillary staff were on duty, however the home appears to require more domestic hours to improve the overall general appearance of the home. This must be considered. Three employee files checked had no induction records evident and only one reference on two of the files. Staff training had taken some priority and was seen to be satisfactory. Staff training was planned for the following three months enabling staff to be competent to do their jobs. 87 of staff had received manual handling training and fire training. 72 of staff had receive Health and Safety training and Resident Welfare training.
Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 and 38 Financial procedures and residents finances were in order. There was no documentation for carer supervision available. Health and safety issues had been addressed. A registered manager must be provided at the home. EVIDENCE: There had been an acting manager in place at the home for 10 months now but there had been no application for registration despite requests by the CSCI. The prospective manager was considering his position at the time of the inspection. Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 18 Quality audits had been carried out by the manager and previous company as routine. However, the audits, including regulation 26 reports had not highlighted some of the failures and problems identified in the last two inspections and complaint reports. Financial procedures were not fully assessed. The company had been taken over by another large well-established company since the last inspection. Residents’ monies were checked and records were found to be in order by the inspector. Formal staff supervision had not been recorded. The health, safety and welfare of the residents was protected by rigorous tests and safety procedures carried out by the maintenance man. These records were found to be excellent. Servicing and maintenance of equipment was also in order. Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 x 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 x 2 2 x x x 2 x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 3 3 1 x 3 Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 19 Regulation 23(2)(b) Requirement The internal premises must be kept in good order and all previous requirements relating to the environment must be addressed. PREVIOUS REQUIREMENT The home must provide adequate bedding and suitable furniture and fittings in communal areas. PREVIOUS REQUIREMENT The premises must be kept in a hygienic state and free from offensive odours. PREVIOUS REQUIREMENT The manager must ensure that the staffing levels and organisation of staff are sufficient to meet the needs of the residents Two written references must be received prior to employing a new member of staff. PREVIOUS REQUIREMENT Staff must be appropriately supervised PREVIOUS REQUIREMENT The home must ensure that the needs of residents are reviewed
DS0000026941.V281704.R01.S.doc Timescale for action 20/02/06 2 20 16(2) (c) 20/02/06 3 19 and 26 16(2) (j)(k) 18(1)(a) 20/01/06 4 27 20/01/06 5 29 2 (5) 20/01/06 6 7 36 4 18(2) 14 (2) 20/02/06 20/01/06 Brindley Court Nursing And Residential Home Version 5.1 Page 21 8 9 10 8 10 11 15(2) 12(4)(a) 18(1)(c) 12(4)(a) 11 12 31 and 32 33 8 and 9 24 (1)(a)(b) and that residents are not accommodated in the home if the category of their assessed needs falls outside that for which the home is registered. PREVIOUS REQUIREMENT The staff must communicate adequately with the residents and their representatives Dignity for residents must be more actively promoted by the staff at the home The home must develop a policy in relation to death of residents. This must include the procedure to be taken in the event of sudden death A registered manager must be provided at the home. PREVIOUS REQUIREMENT Quality auditing, including reg 26 reports must accurately reflect the quality of services provided at the home and must identify actions to be taken in order to address any failings. 20/01/06 20/01/06 20/02/06 20/03/06 20/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 2 8 Good Practice Recommendations The trial period in contracts for self funding residents should be increased from 4 to 6 weeks as it is for residents funded by social services Residents should be reviewed annually by the GP Brindley Court Nursing And Residential Home DS0000026941.V281704.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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